Headache and Pain Research

Review Article

Does Atogepant Offer a Safe and Efficacious Option for Episodic Migraine Prophylaxis? A Systematic Review and Meta-analysis: Ahmed Mostafa Amin, Abdallah Abbas, Samar Ahmed Amer, Hoda Awad, Mahmoud Tarek Hefnawy, Anas Mansour, Mohamed El-Moslemani, Haneen Sabet, Aynur Ozge; Headache Pain Res. 2025;26(1):21-37. Published online February 17, 2025; DOI: https://doi.org/10.62087/hpr.2024.0030

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Migraine, a chronic neurological disorder, imposes a significant burden on individuals and healthcare systems globally. This systematic review and meta-analysis evaluated the efficacy and safety of atogepant in preventing episodic migraine (EM) in adults. A systematic search was conducted in four major databases (PubMed, Scopus, Web of Science, and Cochrane CENTRAL) up to June 2024. The inclusion criteria targeted randomized controlled trials (RCTs) comparing atogepant to placebo or standard care in patients with EM. Statistical analyses were performed using Review Manager (RevMan) software. Four RCTs with 2,018 patients receiving atogepant and 761 patients receiving placebo or standard care were included. Atogepant significantly reduced monthly migraine days compared to placebo at 10 mg daily (mean difference [MD], –1.16 days; 95% confidence interval [95% CI], –1.60 to –0.73), 30 mg daily (MD, –1.15 days; 95% CI, –1.64 to –0.66), 60 mg daily (MD, –1.48 days; 95% CI: –2.36 to –0.61 days), 30 mg twice daily (MD, –1.30 days; 95% CI, –2.17 to –0.43), and 60 mg twice daily (MD, –1.20 days; 95% CI, –1.90 to –0.50). A ≥50% reduction in migraine days was frequently significantly achieved with atogepant across all dosages. Atogepant was generally well tolerated, though it was associated with higher incidence rates of constipation and nausea compared to placebo. Atogepant is an effective and well-tolerated option for preventing EM, offering patients a noninvasive oral alternative to injectable therapies. Further research is warranted to explore its long-term safety and efficacy in diverse patient populations and refine its role in this field.

Citations

Citations to this article as recorded by

Tension-Type Headache and Primary Stabbing Headache: Primary Headaches Beyond Migraine
Mi-Kyoung Kang
Headache and Pain Research.2025; 26(2): 89. CrossRef
The role of Atogepant in migraine prevention: a systematic review and meta-analysis
Naresh Kumar Ladhwani, Priya Bai, Rohan Lal, Aresha Masood Shah, Sheela Bai, Ghazi Uddin Ahmed, Rimsha Zameer, Varisha Fatima Shaikh, Arsalan Hyder, Sikander Ali, Muhammad Hamza Beg, Maheen Adeeb, Mahir Tesfaye
BMC Neurology.2025;[Epub] CrossRef
Gepants for Migraine: An Update on Long-Term Outcomes and Safety Profiles
Soohyun Cho, Kimoon Chang
Headache and Pain Research.2025; 26(3): 184. CrossRef

Original Article

Evidence-Based Recommendations on Pharmacologic Treatment for Migraine Prevention: A Clinical Practice Guideline from the Korean Headache Society: Byung-Su Kim, Pil-Wook Chung, Jae Myun Chung, Kwang-Yeol Park, Heui-Soo Moon, Hong-Kyun Park, Dae-Woong Bae, Jong-Geun Seo, Jong-Hee Sohn, Tae-Jin Song, Seung-Han Lee, Kyungmi Oh, Mi Ji Lee, Myoung-Jin Cha, Yun-Ju Choi, Miyoung Choi; Headache Pain Res. 2025;26(1):5-20. Published online January 16, 2025; DOI: https://doi.org/10.62087/hpr.2024.0019

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Abstract PDF

Purpose: The aim of this clinical practice guideline (CPG) from the Korean Headache Society is to provide evidence-based recommendations on the pharmacologic treatment for migraine prevention in adult migraine patients.
Methods
The present CPG was developed based on the guideline adaptation methodology through a comprehensive systematic search for literature published between January 2012 and July 2020. The overall quality of the CPGs was assessed using the Korean version of the Appraisal of Guidelines for Research and Evaluation II tool. High-quality CPGs were adapted to make key recommendations in terms of strength (strong or weak) and direction (for or against).
Results
The authors selected nine available high-quality guidelines throughout the process of assessment of quality. Regarding oral migraine preventive medications, propranolol, metoprolol, flunarizine, sodium divalproex, and valproic acid are recommended to adult patients with episodic migraines based on high-quality evidence (“strong for”). Topiramate can be recommended for either episodic or chronic migraine (“strong for”). For migraine prevention using calcitonin gene-related peptide monoclonal antibodies, galcanezumab, fremanezumab, erenumab, and eptinezumab are recommended for adult patients with either episodic or chronic migraine on the basis of high-quality evidence (“strong for”). OnabotulinumtoxinA is recommended for adult patients with chronic migraine based on high-quality evidence (“strong for”). Last, frovatriptan, naratriptan, and zolmitriptan are recommended for short-term prevention in women with menstrual migraine (“strong for”).
Conclusion
In the present CPG, the authors provide specific, straightforward, and easy-to-implement evidence-based recommendations for pharmacologic migraine prevention. Nevertheless, these recommendations should be applied in real-world clinical practice based on optimal individualization.

Citations

Citations to this article as recorded by

One-Year Compliance After Calcitonin Gene-Related Peptide Monoclonal Antibody Therapy for Migraine Patients in a Real-World Setting: A Multicenter Cross-Sectional Study
Mi-kyoung Kang, Jong-Hee Sohn, Myoung-Jin Cha, Yoo Hwan Kim, Yooha Hong, Hee-Jin Im, Soo-Jin Cho
Journal of Clinical Medicine.2025; 14(3): 734. CrossRef
Beyond the Pain: Rethinking Migraine Care with the RELIEF PLAN Approach
Sanghyo Ryu
Headache and Pain Research.2025; 26(1): 1. CrossRef
Concurrent Extracerebral Vasoconstriction in Patients with Reversible Cerebral Vasoconstriction Syndrome: A Cross-Sectional Study
Byung-Su Kim, Sumin Kim, Eunhee Kim, Ick-Mo Chung, Sodam Jung, Yoonkyung Chang, Dong Woo Shin, Tae-Jin Song
Journal of Clinical Medicine.2025; 14(13): 4402. CrossRef
Validity of Migraine Diagnoses in Korean National Health Insurance Claims Data
Yoonkyung Chang, Soyoun Choi, Byung-Su Kim, Tae-Jin Song
Headache and Pain Research.2025; 26(2): 154. CrossRef
Tension-Type Headache and Primary Stabbing Headache: Primary Headaches Beyond Migraine
Mi-Kyoung Kang
Headache and Pain Research.2025; 26(2): 89. CrossRef
Injection-Based Therapies for Migraine in Older Adults: A Narrative Review of OnabotulinumtoxinA, Greater Occipital Nerve Block, and Anti Calcitonin Gene-Related Peptide Monoclonal Antibodies
Mi-Kyoung Kang, Soohyun Cho, Byung-Kun Kim, Heui-Soo Moon, Mi Ji Lee, Soo-Kyoung Kim, Hong-Kyun Park, Min-Kyung Chu, Woo-Seok Ha, Byung-Su Kim, Soo-Jin Cho
Journal of Korean Medical Science.2025;[Epub] CrossRef
Use of Antiseizure Medications in Neurological Disorders Beyond Epilepsy
Kyung Min Kim, Byung-Su Kim, Hee-Jin Kim, Seung Woo Kim, Kyoungwon Baik, Jin Myoung Seok, Jun-Sang Sunwoo, In-Uk Song, Ho Geol Woo, Eek-Sung Lee, Jin-Man Jung, Kyomin Choi, Yun Ho Choi, Kwang Ik Yang
Journal of the Korean Neurological Association.2025; 43(4): 245. CrossRef
A Practical Approach to Headache in Moyamoya Disease
Mi-Yeon  Eun, Jin-Man Jung, Jay Chol Choi
Headache and Pain Research.2025; 26(3): 173. CrossRef
Evolution of Migraine Treatment: Recent Drugs and Clinical Trial Trends
Yoon-Kyung Chang, Tae-Jin Song
NeuroTrials.2025; 1(1): 1. CrossRef
Clinical Effectiveness and Cost-Effectiveness of Collaborative Treatment With Korean and Western Medicine for Primary Headache Disorders: Protocol for a Multicenter Prospective Observational Study
Jaeseung Kim, Jihwan Yun, Linae Kim, Shiva Raj Acharya, Changyon Han, NamKwen Kim
JMIR Research Protocols.2025; 14: e82819. CrossRef
Clinical Practice Guideline Recommendations for Post-Acute Sequelae of COVID-19
Jun-Won Seo, Yu Bin Seo, Seong Eun Kim, Yoonjung Kim, Eun Jung Kim, Tark Kim, Taehwa Kim, So Hee Lee, Eunjung Lee, Jacob Lee, Yeong-Hoon Jeong, Yeong Hee Jung, Yu Jung Choi, Joon Young Song
Infection & Chemotherapy.2025; 57(4): 478. CrossRef

Review Article

Treatment Strategies of Medication Overuse Headache: Mi-Kyoung Kang, Jong-Hee Sohn; Korean J Headache. 2023;24(2):33-38. Published online December 31, 2023

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Abstract PDF: Medication overuse headache (MOH) is a common secondary headache disorder in which chronic headaches develop or worsen due to frequent and excessive intake of medications used for acute headache treatment. While the concept of MOH is widely recognized among headache specialists, ongoing debates exist regarding its causes, diagnostic criteria, and treatment strategies. Treating MOH has traditionally been challenging, and there is currently no universal consensus on how to effectively manage patients with MOH. Furthermore, a specific treatment approach based on well-powered randomized trials is still lacking. The treatment strategy for MOH typically involves several steps: patient education and counseling, withdrawal of overused medications, preventive drug therapy, and non-pharmacological prevention. It is recommended that all patients discontinue the overused medication, which can be carried out on an outpatient or inpatient basis. Additionally, topiramate, Botox, and anti-calcitonin gene-related peptide monoclonal antibodies have shown potential in reducing headache and migraine frequency, as well as acute drug consumption, even without active drug withdrawal. However, many aspects of MOH management require further investigation through properly designed and adequately powered randomized controlled trials.

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